Provider Demographics
NPI:1154643237
Name:WICZYNSKI, KAREN PALMER (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:PALMER
Last Name:WICZYNSKI
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, RD, LDN
Mailing Address - Street 1:48 PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-2607
Mailing Address - Country:US
Mailing Address - Phone:603-566-6183
Mailing Address - Fax:
Practice Address - Street 1:373 HIGHLAND AVE STE 201
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2547
Practice Address - Country:US
Practice Address - Phone:617-492-4995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2183133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered